Inflammatory Comments about Tendonitis, Tendon, and Blood Supply

I read most of your website and was impressed by the detailed explanation of tendonitis. Apparently you've done your homework. I have a few unresolved questions however:

1. Is the Inflammation Process an effect or affect? ie: Is it a merely a passive reaction to damage or an intelligent active damage-control process (ex: bleeding v. clotting)?

2. You mentioned that tendons are vulnerable because they lack direct blood supply, but the linked article you provided (@ clinicalsportsmedicine.com) says: "Tendon is supplied by a network of small arteries oriented parallel to the collagen fibres in the endotenon 5, 12, 13." and "A characteristic feature of tendinosis is proliferation of capillaries and arterioles." How do you resolve this discrepancy?

3. If ice treatment causes nearby muscular contraction doesn't that cause indirect additional tension on the tendon so is bad?

4. Does oral Arginine or BCCA or Creatine or any other free aminos have any benefit to speedy healing of the tendon?

From the descriptions provided at other websites, I believe I have either bicep tendonitis or rotator cuff tendonitis (no swelling obvious but soreness near junction of bicep/tricep below right shoulder area behind humerous). I played tennis and had to stop about a month ago. The pain started about 6 months ago gradually but I was having too much fun to stop earlier. :P

Sharp pain occurs only when I reach back, stretch, reach high places with my right arm, or other unusual positions.

I will try the ice treatment as you suggested and see what happens. Nothing else seems to work anyway.

Thanks for any answers you can provide.

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Joshua Answers:

1. Intelligent active.

2. Muscle has artery going right onto and into it. Tendon has artery -close- to it.

When there is a problem in the body, the body triggers now artery growth. For example, small heart artery blockages and tumors cause the body to form 'collateral circulation', new arterial growth to feed the area. Sometimes helpful, sometimes not.

This doesn't seem to help Tendonosis, as the new artery doesn't create a super strong, or even healthy, tendon.

Cold causes small muscle contraction. When you jump in a cold pool or the Arctic ocean, your biceps, for instance, don't totally contract and do a curl.

In other words, a small amount of stress is good. A lot of stress is bad.

4. At this point in time, I don't know the answer to that.

Wrist and elbow tendonitis is easy to get to with ice. A bit tougher in the area you describe. I suggest a frozen water bottle or some such, and arrange it so you can get bodyweight on it, roll around/maneuver around do dig the cold into the area (gently at first, then deeper as appropriate).

That's the funny thing with pain, isn't it? Until we assess it as injury/real problem, no amount of fun can stop us!

I wish I could counter with something witty....but I got nothing today. :)

I tried the ice for a few days but it didn't seem to help. I just got freezer burns on my arm. :(

I'm finding out that nutrients such as sulfur (MSM), proline, and vitamin C all go to rebuilding collagen, cartilage, tendons so I'm going to try that. What do you think?

I'm wondering: If you say inflammation is an 'intelligent' response to injury then why do you and all the meds recommend suppressing it?

If cold causes the 'spongy rebound' effect to aid in circulation to the tendon, then does fingertip massage at the affected area do the same? or not?
It sure would obviate the freezer burns. :O

- Thanks

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Joshua Comments:

Hey B9.

Seriously, something more than just redness and itchyness? From 10 second dips? Hmmm, tell me more.

I think the nutrients you mentioned are valuable and worth getting into your body in adequate amounts.

I also think that one must deal with the entire ecology of the area, which includes relaxing/softening/opening muscle and connective tissue structures.

I said 'intelligent' because that was one of your two options. The nervous system is incredibly intelligent, but sometimes not very smart. Inflammation is one of those dumb ones.

It is useful and helpful in that it is part of the healing process, but there's more involved, and it's kind of like house guests that just linger and never leave and keep eating out of your fridgerator and not cleaning up after themselves...and they have a loud yappy dog....etc.

Fingertip massage is GREAT!!!! Do that!! Ultimately, it's all about circulation and old stuff out and new stuff in and making structures more mobile.

I have a swollen right arm between the forearm and bicep. which it is very tight due to swelling I imagine. The redness and warm to touch is located on the inner side of my right arm. depending on you answer/advise. if treated at home with ice for swelling and if home antibiotics could be used.

Would Keflex 500mg @ day be ok for 7 days. please advise any other options and especially any home remedies avail. is this a very serious issue?

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Joshua Comments:

Hi Anonymous.

Is it serious? I don't know, not enough detail, I have zero clue about what you have going on.